Seon Mee Kim

Prevalence of prehypertension and hypertension in a Korean population : Korean National Health and Nutrition Survey 2001

Objective The present study aimed to determine the prevalence of prehypertension and hypertension, and their association with the risk factors in a Korean population. Design The Korean Nation Health and Nutrition Survey 2001, a cross-sectional survey, was a nationally representative survey in which a stratified multistage sampling design was used. Methods Data from a comprehensive questionnaire, together with a physical examination and blood sample, were obtained from 6074 Korean adults (2620 men and 3454 women) aged ≥ 20 years, and analysed. Results The estimated age-adjusted prevalence of hypertension and prehypertension was 22.9% (26.9% in men, 20.5% in women) and 31.6% (41.9% in men, 25.9% in women), respectively, in the Korean population according to Joint National Committee 7 criteria. Multivariate analysis revealed that age, gender, body mass index, fasting plasma glucose, total-cholesterol and alcohol consumption were significantly associated with hypertension. Overall, only 30.2% of the hypertensive individuals had been previously diagnosed. Furthermore, 22.9% of the hypertensive individuals were being treated with antihypertensive medication, but only 10.7% had their blood pressure adequately controlled. The rates of awareness, treatment and control were higher for the women than for the men, and these rates increased with age. Conclusion Hypertension and prehypertension are common in Korea, and more than one-half of the hypertensive patients have not been diagnosed. These results place great emphasis on the urgent need for a public health program to improve the detection, prevention and treatment of hypertension and prehypertension.

2014 clinical practice guidelines for overweight and obesity in Korea.

The dramatic increase in the prevalence of obesity and its accompanying comorbidities are major health concerns in Korea. Obesity is defined as a body mass index ≥25 kg/m2 in Korea. Current estimates are that 32.8% of adults are obese: 36.1% of men and 29.7% of women. The prevalence of being overweight and obese in national surveys is increasing steadily. Early detection and the proper management of obesity are urgently needed. Weight loss of 5% to 10% is the standard goal. In obese patients, control of cardiovascular risk factors deserves the same emphasis as weight-loss therapy. Since obesity is multifactorial, proper care of obesity requires a coordinated multidisciplinary treatment team, as a single intervention is unlikely to modify the incidence or natural history of obesity.

Dietary patterns and the metabolic syndrome in Korean adolescents: 2001 Korean National Health and Nutrition Survey.

The presence of metabolic syndrome in children and adolescents represents a high-risk state that conveys an increased risk of metabolic disease (1,2). The importance of the role of dietary patterns cannot be overemphasized because of the relation to metabolic disease. Although previous studies show that some dietary patterns are related to the risk of the metabolic syndrome (3–6), these studies focus on adults and were rarely conducted on children or adolescents in a nationally based survey. Therefore, the aim of this study was to identify dietary patterns and to examine the association between dietary patterns and the metabolic syndrome in Korean adolescents. Although studies on the Korean population may yield unique results primarily due to the ethnic homogeneity inherent to the Korean population with very little genetic diversity, the results tend to be applicable to other countries as well. The 2001 Korean National Health and Nutrition Survey, a cross-sectional and nationally representative survey, was conducted from November to December 2001. A stratified, multistage, probability sampling design was used, with selection made from sampling units. Weights indicating the probability of being sampled were assigned to each participant, which enabled the results to represent the entire Korean population. A total of 12,441 individuals participated in the Health Interview Survey, which included a 24-h dietary intake recall. …

Serum adipocyte fatty acid-binding protein, retinol-binding protein 4, and adiponectin concentrations in relation to the development of the metabolic syndrome in Korean boys: a 3-y prospective cohort study.

BACKGROUND Adipocyte fatty acid-binding protein (A-FABP), retinol-binding protein 4 (RBP4), and adiponectin have been associated with insulin resistance and the metabolic syndrome in adults. OBJECTIVE We evaluated the association of A-FABP, RBP4, and adiponectin with the metabolic syndrome in Korean boys. DESIGN In this prospective cohort study, 159 boys participated in a school-based health examination and were followed up after 3 y. The metabolic syndrome in children was defined by using the pediatric adaptation of the National Cholesterol Education Program criteria. RESULTS Compared with normal-weight participants, overweight children had significantly higher A-FABP (23.6 ± 8.2 compared with 12.8 ± 5.1 μg/L, P < 0.001) and RBP4 (69.3 ± 17.1 compared with 59.7 ± 15.3 μg/mL, P = 0.001) concentrations and significantly lower adiponectin concentrations (11.5 ± 5.4 compared with 18.1 ± 8.4 μg/mL, P < 0.001). Baseline A-FABP concentrations were significantly higher in children who developed the metabolic syndrome than in those who did not, whereas adiponectin concentrations were significantly lower. Baseline RBP4 concentrations were not significantly different between the 2 groups. Multiple logistic regression analysis showed that only A-FABP was an independent predictor of the development of the metabolic syndrome after adjustment for Tanner stage, insulin resistance, body mass index, sleep duration, and physical activity (odds ratio: 17.3; 95% CI: 1.25, 239.76; highest compared with lowest tertile), whereas the significant association between adiponectin and the metabolic syndrome observed by using bivariate analysis reflects, in part, an underlying association with obesity. CONCLUSION A-FABP predicts the development of the metabolic syndrome independently of pubertal status, adiposity, and insulin resistance in Korean boys.

Hypoadiponectinemia and insulin resistance are associated with nonalcoholic fatty liver disease

We investigated the association between nonalcoholic fatty liver disease (NAFLD) and plasma adiponectin levels and insulin resistance. We recruited study subjects among one hundred and eighty one persons who were examined abdominal ultrasound at routine screening tests. A standard interview (consumption of alcohol and medical history), physical examination (height, weight, waist circumference, and blood pressure), and biochemical study (lipid parameters, aminotransferases, fasting plasma glucose, fasting insulin, and plasma adiponectin) were performed. Subjects who consumed alcohol more than moderate, evidence of viral hepatitis, toxic hepatitis, and serious cardiac, renal, or hepatic disease were excluded. Thirty-eight NAFLD patients and 53 control subjects diagnosed by ultrasound were finally analyzed. The plasma adiponectin level was significantly correlated with HDL-cholesterol (r=0. 38, p<0.001), triglycerides (r=-0.22, p=0.04), fasting insulin (r=-0.37, p<0.01), and insulin resistance by homeostasis model of assessment-insulin resistance (HOMA-IR) (r=-0.39, p<0.01), after adjusting for age, sex, and adiposity. Multiple logistic regression analysis indicated that HOMA-IR was a significant predictor of having NAFLD (odds ratio [OR]=2.38; 95% confidence interval [CI]: 1.52-5.74), while adiponectin had a protective effect against NAFLD (OR=0.22; 95% CI: 0.09-0.55). We demonstrated that hypoadiponectinemia and insulin resistance are associated with NAFLD independent of obesity.

Full-length adiponectin protects hepatocytes from palmitate-induced apoptosis via inhibition of c-Jun NH2 terminal kinase

Hepatic apoptosis is elevated in patients with non‐alcoholic steatohepatitis and is correlated with the severity of the disease. Long‐chain saturated fatty acids, such as palmitate, induce apoptosis in liver cells. The present study examined adiponectin‐mediated protection against saturated fatty acid‐induced apoptosis in the human hepatoma cell line, HepG2. Cells were cultured in a control media (i.e. without fatty acids) or the same media containing 250 μmol·L−1 of albumin‐bound oleate or palmitate for 24 h. The adiponectin concentrations used were: 0, 1, 10 or 100 μg·mL−1 (n = 4–6 per treatment). Palmitate and thapsigargin, but not oleate, activated caspase‐3 and decreased cell viability in the absence of adiponectin. Adiponectin reduced palmitate‐ and thapsigargin‐induced activation of caspase‐3 and cell death in a dose‐dependent manner. Phosphatidylinositol 3‐kinase and AMP‐activated protein kinase inhibitors abolished the effects of adiponectin. Adiponectin‐induced inhibition of palmitate‐ and thapsigargin‐induced apoptosis was not the result of an augmentation in the unfolded protein response or the increased expression of genes encoding the inhibitor of apoptosis proteins, inhibitor of apoptosis protein‐2 and X‐linked mammalian inhibitor of apoptosis protein. Palmitate and thapsigargin, but not oleate, increased c‐Jun NH2 terminal kinase phosphorylation in the absence of adiponectin. Adiponectin blocked palmitate‐ and thapsigargin‐induced activation of c‐Jun NH2 terminal kinase and reduced apoptosis. These data suggest that adiponectin is an important determinant of saturated fatty acid‐induced apoptosis in liver cells and may have implications for fatty acid‐mediated liver cell injury in adiponectin‐deficient individuals.

25-Hydroxyvitamin D insufficiency is associated with cardiometabolic risk in Korean adolescents: the 2008–2009 Korea National Health and Nutrition Examination Survey (KNHANES)

OBJECTIVE Vitamin D insufficiency is known to be related to cardiometabolic disorders; however, the associations among serum 25-hydroxyvitamin D (25(OH)D) concentration and metabolic syndrome and cardiometabolic risk factors in children and adolescents have not yet been clearly delineated. For this reason, we investigated the relationship among serum 25(OH)D concentration and metabolic syndrome and cardiometabolic risk factors among Korean adolescents. DESIGN We performed a cross-sectional analysis and used hierarchical multivariate logistic regression analysis models to adjust for confounding variables. SETTING We used the data gathered during the 2008-2009 Korea National Health and Nutrition Examination Survey (KNHANES). SUBJECTS Our subjects included 1504 Korean adolescents aged 12-18 years who participated in the KNHANES. RESULTS Vitamin D insufficiency, defined as 25(OH)D concentration <50 nmol/l, was found in 75·3% of Korean adolescents and was associated with an increased risk of the prevalence of metabolic syndrome. Waist circumference and BMI were the most closely correlated cardiometabolic components of metabolic syndrome according to serum 25(OH)D status, but no significant relationship was found between serum 25(OH)D concentration and insulin resistance or for the risks for high blood pressure, hyperglycaemia, reduced HDL-cholesterol or hypertriacylglycerolaemia, with or without adjustment for confounding variables. CONCLUSIONS Low serum 25(OH)D concentration appears to be associated with several cardiometabolic risk factors and an increased risk of the prevalence of metabolic syndrome in Korean adolescents.

Metformin prevents endoplasmic reticulum stress-induced apoptosis through AMPK-PI3K-c-Jun NH2 pathway

Type 2 diabetes mellitus is thought to be partially associated with endoplasmic reticulum (ER) stress toxicity on pancreatic beta cells and the result of decreased insulin synthesis and secretion. In this study, we showed that a well-known insulin sensitizer, metformin, directly protects against dysfunction and death of ER stress-induced NIT-1 cells (a mouse pancreatic beta cell line) via AMP-activated protein kinase (AMPK) and phosphatidylinositol-3 (PI3) kinase activation. We also showed that exposure of NIT-1 cells to metformin (5mM) increases cellular resistance against ER stress-induced NIT-1 cell dysfunction and death. AMPK and PI3 kinase inhibitors abolished the effect of metformin on cell function and death. Metformin-mediated protective effects on ER stress-induced apoptosis were not a result of an unfolded protein response or the induced inhibitors of apoptotic proteins. In addition, we showed that exposure of ER stressed-induced NIT-1 cells to metformin decreases the phosphorylation of c-Jun NH(2) terminal kinase (JNK). These data suggest that metformin is an important determinant of ER stress-induced apoptosis in NIT-1 cells and may have implications for ER stress-mediated pancreatic beta cell destruction via regulation of the AMPK-PI3 kinase-JNK pathway.

Lifestyle modification increases circulating adiponectin concentrations but does not change vaspin concentrations.

The objective of the study was to evaluate the effects of a 10-month lifestyle intervention on the components of the metabolic syndrome (MetSyn) in Koreans with MetSyn as well as on blood concentrations of adiponectin and vaspin. One hundred thirty-eight patients with MetSyn, recruited from a community health care center, were consecutively enrolled in the study; 12 patients dropped of the intervention, leaving 126 subjects (76 men and 50 women; age, 65.3 ± 9.0 years). All participants followed a 10-month lifestyle modification interventional program, including dietary counseling, advice on increasing physical activity, and recommendations to stop or limit smoking and alcohol drinking. Anthropometric and biochemical parameters related to the components of the MetSyn, including blood concentrations of adiponectin and vaspin, were assessed pre- and postintervention. At baseline, adiponectin concentrations were moderately negatively correlated to insulin concentrations and insulin resistance evaluated by the homeostasis model assessment. In response to lifestyle modification, statistically significant changes were found in systolic and diastolic blood pressure, total cholesterol, triglyceride, and insulin concentrations, as well as in homeostasis model assessment of insulin resistance. Adiponectin concentrations postintervention, compared with the preintervention levels, increased (7.2 ± 4.0 vs 6.8 ± 3.9 μg/mL, respectively; P < .05), whereas vaspin concentrations remained unchanged (0.25 ± 0.19 vs 0.26 ± 0.20 ng/mL, respectively; P = .64). A 10-month lifestyle modification program in Korean patients with MetSyn led to favorable changes in metabolic parameters and adiponectin but not vaspin concentrations.

Association between adipocyte fatty acid-binding protein levels and childhood obesity in Korean children.

Adipocyte fatty acid-binding protein (A-FABP) is a newly recognized adipokine that plays a role in the development of obesity and insulin resistance in adults. We investigated the association between A-FABP levels and obesity and insulin resistance in school-aged children. One hundred sixty-one 9-year-old Korean children (80 boys and 81 girls) voluntarily participated in this study at school-based health examinations. Weight, height, waist circumference, and blood pressure were measured. Fasting plasma glucose, triglycerides, high-density lipoprotein cholesterol, insulin, and A-FABP levels were measured; and insulin resistance was estimated by the homeostasis model assessment. Subjects with higher body mass index (BMI) percentiles had correspondingly higher concentrations of A-FABP in both boys and girls. Subjects within the highest quartile of A-FABP levels had correspondingly poor metabolic risk profiles (BMI, waist circumference, triglycerides, high-density lipoprotein cholesterol, fasting insulin, and homeostasis model assessment of insulin resistance) compared with those in the lowest A-FABP quartile (P < .01). Serum A-FABP concentrations were significantly correlated with BMI (r = 0.58, P < .01) and waist circumference (r = 0.51, P < .01). However, the significant correlation between serum A-FABP and insulin resistance faded after adjustment for BMI. Adipocyte fatty acid-binding protein was closely associated with obesity or abdominal obesity in children; however, the independent relationship between A-FABP and insulin resistance in children is still unclear and remains to be determined.